Volume 102, Issue 3 (2003)

Editorials

As we delve into the topic of women’s health, we are honored and flattered to have guest editorials from Helene Nelson, surely one of the most knowledgeable people about health and social services in Wisconsin, and Sue Ann Thompson, who has made valued contributions to the WMJ previously. Both are significant figures in women’s—and men’s—health and we are grateful for their thoughts. Ms Nelson (p 13) reminds us that our counseling can have a significant impact on changing patients’ behaviors and that an extra minute or two spent doing that is well worthwhile. Ms Thompson, in turn, points out that women make over 80% of family health care decisions (p 15) and it behooves us to ensure that they be provided with appropriate information to guide those decisions.

I congratulate the Wisconsin Med-ical Society and the WMJ and its readers for your interest in promoting the health of all people in our state, and for addressing the specific health care needs of women. I also appreciate the willingness of physicians to serve poor and elderly women through the Medicaid program.

As scientific evidence points to the significant impact that daily lifestyle choices have on health, individuals are becoming increasingly responsible for their personal wellness. Likewise, individuals must view their relationship with their health care provider as a partnership; doctors make recommendations based on experience and expertise, but the patient must ultimately make the final decision about the course of treatment.

Because of the magnitude of women’s health issues within the larger context of public health and healthcare systems, this paper was written to help define the current status of women’s health in Wisconsin. Utilizing critical women’s health areas identified by the Wisconsin Women’s Health Foundation and the Wisconsin Division of Public Health, 16 specific measures of women’s health were chosen for this analysis. The most recent data available for each measure were collected with Wisconsin data being compared to national averages as well as to Healthy People 2010: Objectives for Improving Health targets. Wisconsin women fare better than national averages in nine of the selected health measures; however, there are still many improvements to be made in order to meet Healthy People 2010 targets. The areas where the most improvements are needed include binge drinking, tobacco use, diabetes, and stroke mortality. Other significant findings include the lack of uniformly collected data in the areas of domestic violence, osteoporosis, and mental illness.

Despite the many dangers associated with smoking during pregnancy, it remains a salient public health problem for Wisconsin women. The First Breath pilot program was developed in an attempt to reduce rates of smoking during pregnancy among low-income women. Preliminary results suggest that the First Breath counseling-based approach is effective, with a quit rate of 43.8% among First Breath enrollees at 1 month postpartum. Women receiving First Breath cessation counseling also had higher quit rates at every measurement period versus women in a comparison group who were receiving whatever cessation care was available in their county in the absence of First Breath. The First Breath pilot study has demonstrated success in helping pregnant women quit smoking and in creating a model for integration of cessation services into prenatal health care service provision. It is through this success that First Breath is expanding beyond the pilot study stage to a statewide program in 2003.

Strangulation accounts for 10% of all violent deaths in the United States. Many people who are strangled survive. These survivors may have minimal visible external findings. Because of the slowly compressive nature of the forces involved in strangulation, clinicians should be aware of the potential for significant complications including laryngeal fractures, upper airway edema, and vocal cord immobility. Survivors are most often assaulted during an incident of intimate partner violence or sexual assault, and need to be specifically asked if they were strangled. Many survivors of strangulation will not volunteer this information. Accurate documentation in the medical chart is essential to substantiate a survivor’s account of the incident. Medical providers are a significant community resource with the responsibility to provide expert information to patients and other systems working with survivors of strangulation. This case study reviews a strangulation victim who exhibited some classic findings.

Nausea and vomiting commonly occur in pregnant women. Hyperemesis gravidarum is a severe form of nausea and vomiting rarely occurring in pregnancy. Between 0.3% and 2% of all pregnant women suffer from hyperemesis gravidarum. The objective of this paper is to review current literature focusing on the definition, incidence, etiology, prognosis, and treatment of hyperemesis gravidarum. A MEDLINE search of the English literature from 1982 through 2001 utilized the keywords hyperemesis gravidarum, nausea, and pregnancy. Current data pertaining to the epidemiology, etiology, clinical presentation, various treatment modalities, and prognosis are presented. Review of the literature supports that hyperemesis gravidarum is a multifactorial disease. The cause is unknown. Various treatments are recommended although few studies have evaluated effectiveness. A case report of molar pregnancy presenting with hyperemesis gravidarum introduces this literature review.

Osteoporosis is a devastating disease that is increasing in prevalence as our population ages. Prevention of osteoporosis is important to decrease osteoporosis-related fractures. Primary care practitioners are in the ideal position to actively screen women for osteoporosis and counsel them on risk reduction. This paper reviews population-based strategies for osteoporosis prevention and identification of high-risk women in a primary care practice. Practical methods of incorporating osteoporosis prevention counseling into a busy practice are presented.

Your Practice

With people living longer and health care costs rising at a staggering rate, caring for an aging spouse, parent, or relative is taking a financial toll on many families. In fact, the Journal of the American Medical Association recently found that one third of families caring for a seriously ill relative spend most or nearly all of their life savings. In addition, more and more families are facing this financial, and often emotional, crisis. According to the American Association for Retired Persons, approximately one in four households is now providing caregiving to a relative or friend aged 50 and over.

Your Profession

Everyone has known for quite some time that some diseases occur disproportionately in women, while others occur more frequently in men. Until very recently, we assumed that hormones and reproductive systems alone were responsible for these differences. Ever so slowly, however, the medical and research communities are beginning to recognize that underlying biological factors play a critical role in such discrepancies.

The first two installments in this series documented the stress facing our profession and the need for the medical profession to recover. We defined professionalism and listed the barriers to implementation of professionalism. In this issue we address how physicians and patients can work together to reduce the barriers we all face. We document a variety of strategies designed to improve the physician/patient relationship. Many of these strategies have in common the idea of promoting a better dialogue, be it with patients, with businesses, in our communities, or with other professionals. This is just a beginning though. This fall, we will continue the dialogue with a Patient Congress. By bringing together patients and physicians we hope to directly work toward improving and strengthening the special relationship that patients and physicians have historically had. More information on the Patient Congress will appear in a future issue of the WMJ.

Reviewed by Earl ThayerBook Review: 184 Years of Medicine in Brown County
(full text PDF)

Between those two paragraphs Benson L. Richardson, MD, a retired internist-endocrinologist from Green Bay, delivers a eulogy on the death of independent medical practice in his 141-page book History of Medicine in Brown County, Wisconsin 1816-2000. Under the subtitle A Transition, Independent Medical Practitioner to Multispecialty Clinic Provider, Richardson expresses frequent longing for the “golden years” of patient-doctor relationships, yet nowhere does he suggest that patients aren’t better off for the enormous changes that have come to health care since those years of which he writes with such aching nostalgia.